Migraine is a frequent paroxysmal neuro-vascular disorder, characterized by recurrent attacks of disabling headache, vomiting, photo/phonophobia, malaise, and other general symptoms (migraine without aura). Up to 20% of patients may, in addition, experience transient neurological (aura) symptoms during attacks (migraine with aura) (HCC, 1988). Up to 24% of females and 12% of males in the general population are affected, however with variable attack frequency, duration and severity (Russell et al., 1995). Knowledge about the mechanisms of the final common pathway of migraine attacks has increased substantially the last five years, resulting in improved, though still only symptomatic (and sub-optimal) acute treatment for the attack. There is, however, still very little knowledge about the etiology of migraine attacks, i.e. why and how attacks begin and recur. Accordingly, prophylactic treatment for migraine is non-specific and has only limited efficacy.
Family, twin and population-based studies suggest that genetic factors are involved In migraine, most likely as part of a multifactorial mechanism (reviewed by Haan et al., 1996). The complex genetics has hampered identification of candidate genes for migraine. Familial Hemiplegic Migraine (FHM) is a rare, autosomal dominant, subtype of migraine with aura, associated with ictal hemiparesis and, in some families cerebellar atrophy (HCC, 1988). Otherwise, the symptoms of the headache and aura phase of FHM and xe2x80x9cnormalxe2x80x9d migraine attacks are very similar and both types of attacks may alternate within subject and co-occur within families. FHM is thus part of the migraine spectrum and can be used as a model to study the complex genetics of the more common-forms of migraine (Haan et al., 1996). A gene for FHM has been assigned to chromosome 19p13 in about half of the families tested (Joutel et al., 1993; Ophoff et al., 1994; Joutel et al., 1995). Remarkably, cerebellar atrophy was found only in families with FHM linked to chromosome 19p13, but not in unlinked families. Recently, we showed the 19p13 FHM locus to be also involved in xe2x80x9cnormalxe2x80x9d migraine (May et al., 1995).
Episodic ataxia type 2 (EA-2) is another, autosomal dominant, paroxysmal neurological disorder, characterized by acetazolamide-responsive attacks of cerebellar ataxia and migraine-like symptoms, and interictal nystagmus and cerebellar atrophy. Recently, a gene for EA-2 was assigned to chromosome 19p13, within the same interval as for FHM (Kramer et al., 1995). This finding, as well as the clinical similarities, raise the possibility of EA-2 and FHM being allelic disorders.
Since other hereditary episodic neurological disorders responding to acetazolamide (such as hypokalaemic and hyperkalaemic periodic paralysis), as well as EA type-1 A (which, in contrast to EA-2, is associated with continuous myokymia and non-responsive to acetazolamide) have all been associated with mutations in genes encoding for ion channels (Ptacek et al., 1991; Ptacek et al., 1994; Brown et al., 1994), we specifically looked for similar genes within the FHM and EA-2 candidate region.
In view of the above, the FHM/EA-2 locus can, since FHM is part of the migraine spectrum, thus be used to study the genetic factors and biological mechanisms that are related to various episodic neurological disorders such as FHM, EA-2, common migraine and others such as epilepsy.
Calcium channels are multisubunit complexes composed of at least an xcex11, an xcex12xcex4, and a xcex2 subunit. The central xcex11 subunit is functionally the most important component, acting as a voltage sensor and forming the ion-conducting pore. The other subunits have auxiliary regulatory roles. The membrane topology of the xcex11 subunit consist of four hydrophobic motifs (I to IV), each containing six transmembrane xcex1-helices (S1-S6) and one hairpin (P) between S5-S6 that spans only the outer part of the transmembrane region.
The present invention provides an isolated and/or recombinant nucleic acid, or fragments thereof, encoding a Ca2+-channel xcex11 subunit related to familial hemiplegic migraine and/or episodic ataxia type-2, derived from a gene present on chromosome 19p13.1-19p13.2; a gene encoding the xcex11 (ion-conducting) subunit of a P/Q-type voltage gated calcium channel. The present invention also provides access to and methods to study the genetic background and identify other subunits of the calcium channel subunit complexes and the proteins related therewith that are associated with the genetic factors and biological mechanisms that are related to various episodic neurological disorders such as FHM, EA-2, common migraine and others such as epilepsy which are related to cation channel dysfunction.
The sequence of the cDNA of the gene is highly related (xe2x89xa790%) to a brain-specific rabbit and rat voltage gated P/Q-type calcium channel al subunit (Mori et al., 1991; Starr et al., 1991), and the open reading frame consists of 2261 amino acid residues. Northern blot analysis showed a brain-specific expression, especially in the cerebellum. Primary study of a cosmid contig harbouring the gene already indicated an exon distribution over at least 300 kb of genomic DNA. Recently, a neuronal Ca2+ xcex11A subunit gene was localized to chromosome 19p13.1-p13.2 by FISH analysis (Diriong et al, 1995). The gene symbol is CACNL1A4 and the al subunit is classified as a P/Q-type. No sequence data for the CACNL1A4 gene have been provided by Diriong or others, but the same localization (chromosome 19p13.1) and the identical classification (P/Q-type) suggests that the Ca2+ channel xcex11 subunit we have identified is very similar to CACNL1A4. No relation with migraine has been disclosed for CACNL1A4. The genomic structures of three other human Ca2+ channel xcex11 subunit genes (CACNL1A1, CACNL1A2 and CACNL1A3) have been published to date (Hogan et al, 1994; Soldatov, 1994; Yamada et al, 1995). Both CACNL1A1 and CACNL1A2 span about 150 kb and consist of 50 and 49 exons, respectively. The smaller CACNL1A3 gene is composed of 44 exons, distributed over 90 kb.
The present invention also provides an isolated and/or recombinant nucleic acid comprising alleles of the invented gene which contain mutations relevant to the occurence of migraine and other neurological disorders which are related to cation channel dysfunction. Such mutations are for example a mutation at codon 192 resulting in the replacement of arginine by glutamine (R192Q), and/or a mutation at codon 666 resulting in the replacement of threonine by methionine, and/or a mutation at codon 714 resulting in a replacement of valine by alanine and/or a mutation at codon 1811 resulting in a replacement of isoleucine by leucine, but also other mutations of alleles of said gene which bear relationships with cation channnel dysfunction.
The present invention also provides isolated and/or recombinant nucleic acid comprising alleles of said gene which contain a polymorphic CA-repeat sequence specific for various alleles of said gene. The present invention also provides isolated and/or recombinant nucleic acids comprising alleles of said gene which contain a CAG repeat.
The present invention also provides methods and tests (such as PCR, but also other tests to detect or amplify nucleic acids are known in the art) to detect, identify and localize or distinguish genes and alleles of such genes, or fragments thereof, encoding for proteins or xcex1, xcex2 or "khgr" sub-units of specific cerebral cation channels, more specifically the invented gene and its various alleles encoding the xcex11 subunit of a P/Q-type voltage gated calcium channel and the gene encoding the xcex22 sub-unit, which are involved in the primary pathogenesis of neurological disorders such as FHM, migraine, EA-2 and SCA6. With such methods and tests one can study abnormalities of said gene.
The invention also provides recombinant expression vectors comprising isolated and/or recombinant nucleic acid comprising alleles of said genes or fragments therof, and provides host cells or animals that comprise such vectors or that are otherwise transformed with an isolated and/or recombinant nucleic acid according to the invention.
The invention thus also provides a rationale and methods for the testing and the development of specific prophylactic medication for migraine and other episodic neurological, in particular brain, disorders, such as epilepsy, associated with cation channel dysfunction.
The invention for example provides cells or animals that comprise recombinant vectors that comprise variants of said genes or cells or animals that are transformed with said variants. Also, the invention provides means to identify naturally occuring variants of experimental animals with changes in said gene related to FHM, EA-2, SCA7, migraine or other neurological disorders associated with cation channel dysfunction. An example of such an animal is the tottering mouse, and its variants called leaner and rolling, described in the experimental part of the invention. The invention also provides cells or animals in which changes such as deletions or mutations in said gene have been introduced by recombinant nucleic acid techniques. All such cells or animals provided by the invention can be used to study the pathophysiology of FHM, EA-2, migraine or other neurological disorders associated with cation channel dysfunction, for example to test or develop specific medication for the treatment of said disorders.
The invention also provides proteins or peptides encoded by said genes, or fragments thereof, related with cation channel dysfunction, and detection of such proteins or peptides by antibodies directed against said proteins or peptides. Such antibodies can be of natural or synthetic origin, and can be produced by methods known in the art. Such proteins and antibodies and detection methods can be used to further in vitro or in vivo studies towards the pathophysiology of FHM, EA-2, migraine or other neurological disorders associated with cation channel dysfunction, in addition such proteins, antibodies and detection methods can also be used to diagnose or identify such disorders in patients or in experimental animals.
Sixteen FHM patients were selected, including eight individuals from four unrelated chromosome 19-linked FHM families (NL-A, UK-B, USA-C (Ophoff et al, 1994), and USA-P (Elliot et al., 1995), two affected individuals from two small FHM families from Italy (Italy I and II) and six individuals with sporadic hemiplegic migraine (i.e. no other family member was shown to suffer from attacks of hemiplegic migraine). In families NL-A and USA-P cerebellar ataxia and/or nystagmus is associated with FHM. An additional set of four subjects from four unrelated EA-2 families linked to chromosome 19, was also included (CAN-25, -45, -191, -197. Fifty randomly collected individuals from the Dutch population (Smith et al., 1988) were used as a control to determine the allele frequencies of polymorphic sites.
Patients with migraine with or without aura were diagnosed according to the international Headache-Society (IHS) classification criteria. Patients attending the neurology outpatient clinic of Leiden University Medical Center, The Netherlands, and patients responding to calls in local newspapers or in the periodical of the Dutch Migraine Patients Association, were screened for a positive family history of migraine. Only families with migraine in at least two generations were asked to participate. Probands (n=36) and relatives (n=492) were personally examined and interviewed using semi-structured questionnaires. The questionnaire included questions about age at onset, frequency and duration of attacks, aura symptoms, premonitory signs and symptoms, triggers for attacks, medication, and additional headaches. When family members were not available for a personal interview, information on their migraine was collected by interviewing their relatives. Because of the low validity of diagnosing migraine auras through relatives, we only assessed the presence or absence of migraine headaches. Whenever possible, medical records were examined.
Ten different cosmids from the contig extending the invented gene, were subcloned separately in either M13 or pBlueScript KS vector. From each cosmid library at least 3xc3x9796 random clones with an average insert size of about 2 kb, were picked. Positive clones were identified by hybridization techniques and subsequently sequenced with vector-specific primers; intron-exon boundary sequences were completed using cDNA-based primers.
Genomic DNA was used as template to generate polymerase chain reaction (PCR) products for single-strand conformational polymorphism (SSCP) analysis and denaturing high-performance liquid chromatography (DHPLC). Amplifications were performed in standard conditions with primer pairs as listed in Table 1 or listed below. Except for the 5xe2x80x2 side of exon 6, primers were chosen to produce fragments that contained a single exon and at least 35 basepairs (including primer) of each flanking intron sequence. Amplification of exons 1 and 20 was performed producing two overlapping fragments and exon 19 was amplified into three overlapping fragments. In addition, the following markers;
D10S191 Primer sequence 1 (SEQ ID NO: 141) CTT TAA TTG CCC TGT CTT C
Primer sequence 2 (SEQ ID NO: 142) TTA ATT CGA CCA CTT CCC
D10S245 Primer sequence 1 (SEQ ID NO: 143) AGT GAG ACT CGT CTC TAA TG
Primer sequence 2 (SEO ID NO: 144) ACC TAC CTG AAT TCC TGA CC
DIOS89 Primer sequence 1 (SEQ ID NO: 145) AAC ACT AGT GAC ATT ATT TTC A
Primer sequence 2 (SEQ ID NO: 146) AGC TAG GCC TGA AGG CTT CT
DHPLC (Oefner et al., 1995; Hayward et al., 1996) was carried out on automated HPLC instrumentation. Crude PCR products, which had been subjected to an additional 3-minute 95xc2x0 C. denaturing step followed by gradual reannealing from 95-65xc2x0 C. over a period of 30 minutes prior to analysis, were eluted with a linear acetonitrile (9017-03, J. T. Baker, Phillipsburg, N.J., USA) gradient of 1.8% per minute at a flow-rate of 0.9 ml/min. The start- and end-points of the gradient were adjusted according to the size of the PCR products (Huber et al., 1995). The temperature required for successful resolution of heteroduplex molecules was determined empirically by injecting one PCR product of each exon at increasing mobile phase temperatures until a significant decrease in retention was observed.
For SSCP analysis, primary PCR products were labeled by incorporation of [xcex1-32P]dCTP in a second round of PCR. Samples were diluted and denatured in formamide buffer before electrophoresis. SSCP was carried out according to published protocols (Orita et al., 1989; Glavac et al., 1994). Digestion of several exons to yield products suitable for SSCP analysis.
Sequencing of PCR products was performed with an ABI 377 automated sequencing apparatus with cycle sequencing according to the manufacturer. Furthermore, PCR products were cloned in the TA vector (Invitrogen) and subjected to manual dideoxy sequence analysis (T7 Sequencing kit, Pharmacia Biotech.).
A total of 481 blood samples were collected from patients with migraine. Genomic DNA was isolated as described by Miller et al., 1988. The analyses of the highly informative microsatellite markers D19S391, D19S394, D19S221 and D19S226, D10S191, D10S248 and D10S89 were performed by PCR; primer sequences related to these markers are available through the human Genome Data Base (GDB).
The relative frequencies of marker alleles were estimated on the entire family material, with the relevant correction for genetic relationships between individuals (Boehnke, M, 1991) with the ILINK option of the I-INKAGE package, version 5.03 (Lathrop et al., 1985). The following marker order and recombination frequencies were used in the multipoint sib-pair analysis: D19S391-5%-D19S394-3%-D19S221-5%-D19S226. Affected-sib-pair analysis was performed using the MAPMAKER/SIBS software package, simultaneously including marker information for all four DNA markers (Kruglyak, 1995). Separate analyses were performed for migraine with aura, migraine without aura, and a combination of both. Allowance was made for dominance variance. When more than two affected sibs occurred in a single sibship, weighted scores were computed according to Suarez and Hodge (1979).
In a sib-pair analysis, the occurrence of parental marker alleles is compared among sibs. Normally, 25% of sib pairs share their marker alleles from both parents, 50% share one marker allele from one of their parents, while the remaining 25% share no parental allele. Deviations from this pattern towards increased sharing, and consistent with the constraints of Holmans""s (1993) possible triangle, are explained as linkage (expressed as the maximum lod score MLS). Increased sharing of marker alleles thus indicate that the marker is located closely near a genetic risk factor. The relative-risk ratio for a sib (xcexR), defined as the ratio of the prevalence of a disease in sibs of affected individuals, divided by the prevalence of a disease in the population, can be calcutated (May et al., 1995). In other words:       λ    p    =            Affected      ⁢              xe2x80x83            ⁢      risk      ⁢              xe2x80x83            ⁢      for      ⁢              xe2x80x83            ⁢      sib      ⁢              xe2x80x83            ⁢      of      ⁢              xe2x80x83            ⁢      a      ⁢              xe2x80x83            ⁢      proband              Affection      ⁢              xe2x80x83            ⁢      risk      ⁢              xe2x80x83            ⁢      for      ⁢              xe2x80x83            ⁢      an      ⁢              xe2x80x83            ⁢      individual      ⁢              xe2x80x83            ⁢      in      ⁢              xe2x80x83            ⁢      the      ⁢              xe2x80x83            ⁢      general      ⁢              xe2x80x83            ⁢      population      
The combination of hybridization and PCR strategies resulted in a rapid assembly of the complete coding sequence of the human cDNA, with an open reading frame of 6783 nucleotides encoding 2261 amino acid residues (FIG. 4). The spatial distribution of the human Ca2+ channel expression was assayed in rhesus monkey tissues. Total RNA was isolated from several tissues, including various brain structures, and probed with a human cDNA fragment. The probe detected a major transcript of approximately 9.8 kb in cerebellum, cerebral cortex, thalamus and hypothalamus, whereas no transcript was detected in heart, kidney, liver or muscle. There was also no hybridization signal found in RNA preparations from mouse skin tissue or from human peripheral lymphocytes. In addition, an attempt to amplify parts of the cDNA from human peripheral lymphocytes failed.
Complete alignment between the cDNA and individual exon sequences was achieved, allowing the establishment of the exon-incron structure (Table 1). The reconstruction of the exon-intron structure of the CACNL1A4 gene revealed 47 exons ranging in size from 36 bp (exon 44) to 810 bp (exon 19). The exons are distributed over about 300 kb at genomic DNA level. The result shows that the first 10 exons are located in a region of about 150 kb covered by the first 5 cosmids of the contig indicating relatively large introns at 5xe2x80x2 side of the gene. Sequences (FIG. 1) were obtained of all exons including approximately 100 bp of flanking introns, except for intron 5 adjacent to exon 6. The forward primer of exon 6 harbours the splice junction and 3 bp of exon 6. Splice sites around all exons are compatible with consensus sequence with the exception of splice donor and acceptor of the first intron.
The cosmid conzig that yielded the initial Ca2+ channel gene exons was extended to cover more than 300 kb. Hybridization experiments showed that the first and last cosmids of the contig were positive for 3xe2x80x2- and 5xe2x80x2-end cDNA sequences, respectively, indicating a genomic distribution of the gene over at least 300 kb (FIG. 2). The cosmid contig has been placed into the LLNL physical map of chromosome 19 at band p13.1, between the markers D19S221 and D19S226 (FIG. 2). We identified a new polymorphic CA-repeat sequence (D19S1150) on the cosmid contig. Oligonucleotide primers (Table 1) flanking the repeat were synthesized and amplification was performed by PCR as described. Analysis of D19S1150 in 45 random individuals from the Dutch population revealed nine alleles with an observed heterozygosity of 0.82. This highly polymorphic marker is located within the gene and is therefore very useful in genetic analysis.
Exons and flanking intron sequences, containing the complete coding region of CACNL1A4 and part of untranslated sequences, were screened for the presence of mutations by SSCP and DHPLC analysis in 20 individuals with either FHM or EA-2. Several synonymous nucleotide substitutions and polymorphisms were identified including a highly polymorphic (CAG)n-repeat in the 3xe2x80x2 untranslated region of exon 47 (Table 2). Of all polymorphisms only one was identified predicting an amino acid change, an alanine to threonine substitution at codon 454 (A454T).
Four different missense mutations were found in FHM patients of which one mutation was observed in two unrelated FHM affected individuals (Table 3). The mutations were shown to segregate with the disease within the families, and were not present in about 100 control chromosomes. A G-to-A transition was identified in family Italy-II at codon 192, resulting in a substitution of arginine to glutamine (R192Q) within the first voltage sensor domain (IS4). A second missense mutation occurs at codon 666, within the P-segment of the second repeat replacing a threonine residue for methione (T666M) in family USA-P. Two other mutations are located in the 6th transmembrane spanning segment of respectively repeat II and IV. The IIS6 mutation is a T-to-C transition at codon 714, resulting in a substitution of valine to alanine (V714A), identified in FHM family UK-B. The mutation in domain IVS6 is an A-to-C transversion at codon 1811 resulting in a substitution of isoleucine to leucine (I1811L). This I1811L mutation is found in family NL-A and family USA-C, two unrelated FHM families. Comparison of haplotypes in this region, including intragenic markers, did not reveal any evidence for a common founder of family NL-A and USA-C (data not shown). No mutation was found in FHM family Italy-I nor in the six sporadic hemiplegic migraine patients. In addition to missense mutations in FHM families, we also identified mutations in two out of four EA-2 families (Table 3). In EA-2 family CAN-191, a basepair deletion occurs in exxon 22 at nucleotide position 4073 causing a frameshift and a premature stop. The second EA-2 mutation is a transition of G-to-A of the first nucleotide of intron 24, predicted to leading to an aberrant splicing in family CAN-26. The invented gene also contains a CAG repeat, of which expansions have been found in patients with autosomal dominant cerebellar ataxia (SCA6). Hence FHM, EA-2 and SCA6 are alielic ion channel disorders and different mutations are associated with different clinical symptomatologies.
Our study patients with common migraine (with or without aura) included 36 independent multigenerational Dutch families. At least some data were available on 937 family members and 212 persons who xe2x80x9cmarried-inxe2x80x9d (spouses). Of these, 442 family members (247 affected) and 86 spouses (7 affected) were personally interviewed. The distribution of the different types of migraine among the 247 affected family members are as follows: 132 family members showed migraine without aura, 93 showed migraine with aura and 22 showed months-migraine, not fulfilling all critera by IHS. Among the 7 affected spouses these figures were 4, 1 and 2, respectively. We scored the parental transmission of migraine in the 36 families (Tabel 4) to investigate if an additional X-linked dominant or mitachondrial aene was involved. An approximately 2.5:1 preponderance of females among the migraine sufferers was noted, which remained in the affected offspring. Affected fathers were found to transmit migraine to their sons in 21 cases, making X-linked dominant or mitochondrial inheritance highly unlikely.
The genetic analysis included 204 potentially affected sib pairs; after correction for more than one sib pair in a single sibship the total number of sib pairs was 108. Affected-sib-pair analysis was performed for sib pairs who were both affected with any form of migraine and, in separate analyses, for sib pairs who where both suffering from either migraine with aura or migraine without aura. The informativeness of the region between the markers D19S391, D19S394, D19S221 and D19S226 varied between 82% and 96%. The combined analysis of migraine with and without aura resulted in a maximum multipoint lod score of 1.69 (p≈0.005) with marker D19S226. For migraine with aura the maximum multipoint lod score was 1.29 corresponding with p≈0.013 with marker D19S394. The maximum lod score for migraine without aura was not significant (MLS  less than 0.25)(data not shown). The relative risk ratio for a sib to suffer from migraine with aura (xcexp), defined as the increase in risk of the trait attributable to the 19p13 locus, varied between xcexR=1.5 (for marker D19S394) and xcexR=2.4 (for marker D19S226). When combining migraine with and without aura, xcexR was 1.25. In a selected portion of 36 Dutch families with migraine with aura and without aura, affected sib-pair analysis was performed for sib pairs who were affected with any form of migraine. The following markers, flanking the xcex22(CACNB2) calcium channel subunit gene on chromosome 10p12, were tested: D108191, D1OS246 and D10S89. For the combined phenotype (migraine with and without aura) a maximum pultipoint iod score of 0,95 (p less than 0,01) was obtained with marker; D10S191. This result gives independent evidence for a role of the P/Q type Ca2+ channel in migraine and other neurological disorders.
The genomic structure of the exemplified invented gene revealed 47 exons distributed over about 300 kb (Table 1; FIG. 1). A comparison of the gene structure to already known Ca2+ channel al subunit genes (CACNL1A1, CACNL1A2, and CACNL1A3) (Soldatov, 1994; Yamada et al., 1995; Hogan et al., 1995), reveals a similar number of exons (50, 49, and 44 respectively) but a larger genomic span (300 kb vs 90-150 kb). Remarkebly, all splice sites are according to consensus sequence except for intron 1. Splice donor as well as splice acceptor of the first intron do not contain the expected gt . . . ag intron sequence. An incorrect CDNA sequence is unlikely because the cDNA sequence containing the junction of the first two exons is identical to rabbit and rat sequence. Sequences corresponding to splice donor and acceptor are present in exon 1 and 2, suggesting an additional (yet unidentified) exon in the first intron encompassing part of sequences of exon 1 and exon 2.
To test the possible involvement of the invented gene relating to the CA2+-channel sub-unit in migraine FHM, SCA6 and EA-2, we performed a mutation analysis by DHPLC and SSCP and found several alterations (For example Table 2 and 3). Only one missense variation was observed also present in 2% of the normal controls (Table 2). This polymorphism is a alanine to threonine substitution at codon 454 (A454T), located in the intracellular loop between IS6 and IIS1 (FIG. 2). This region contains a conserved alpha interaction domain (AID) that binds subunits (De Waard et al., 1996). However, A454T is located outside the AID consensus sequence and is not likely to be involved.
The identification of two mutations that disrupt the predicted translation product of the invented gene in two unrelated EA-2 patients and the segregation of these mutations with the episodic ataxia phenotype in their families provide strong evidence that the invented gene is the EA-2 gene. A basepair deletion leads to a frame-shift in the putative translation product and encounters a stop codon in the next exon. The frame-shift in this EA-2 family is predicted to yield a calcium channel al subunit polypeptide consisting of repeat I and II, and a small portion of repeat III (IIIS1). The G-to-A transition of the first nucleotide of intron 24 is affecting the nearly invariant GT dinucleotide of the intronic 5xe2x80x2 splice junction. The brain-specific expression of the exemplified invented gene makes it extremely difficult to test the hypothesis that this mutation produces aberrantly spliced RNAs by retaining the intron or utilizing other cryptic 5xe2x80x2 splice sites.
The frameshift and splice site mutations in EA-2 may suggest a dominant negative effect of the truncated proteins by overruling the (corresponding) intact al subunits.
No mutations were found in the remaining EA-2 families (CAN-25 and -197). The use of two independent techniques for mutation screening (DHPLC and SSCP) makes it unlikely that we missed a heterozygote PCR product. Mutations in the promoter region or in intron sequences, resulting in aberrant splicing, may have been the cause of EA-2 in these families. We could also have missed a mutation around the splice acceptor site of intron 5, covered by the forward primer of exon 6. However, larger deletions of e.g. complete exons with flanking intron sequence will disturb the predicted translation product, like the xcex94C4073 and splice site mutation do, but this is not detectable by a PCR-based screening method but can be seen Southern blot analysis instead.
Four different missense mutations were identified in five unrelated FHM families. These mutations all segregate with FHM within a family and are not observed in over 100 normal chromosomes. The first missense mutation that we describe in the exemplified invented gene occurs in the IS4 domain of the al subunit (Table 3; FIG. 3). The S4 domains are postulated to be voltage sensors because they have an unusual pattern of positively charged residues at every third or fourth position separated by hydrophobic residues (Tanabe et al., 1987). In calcium channels the positively charged amino acid is an arginine residue (Stea et al., 1995). The mutation in FHM family Italy-II predicts a substitution of the first arginine in the IS4 segment with a neutral, non-polar alutamine (R192Q). The change of the net positive charge of this conserved region of the protein may influence correct functioning of the voltage sensor.
The second missense mutation in FHM family USA-P occurs in the P-segment of the second transmembrane repeat. A C-to-T transition predicts substitution of a threonine residue with methionine at codon 666 (T666M). Various observations have shown that P-segments, the hairpin between S5 and S6 that spans only the outer part of the transmembrane region, form the ion-selectivity filter of the pore and binding sites for toxins (Guy and Durell (1996). Alignment of protein sequence of different P-segments indicating that some residues occur in many different channel genes (Guy and Durell, 1996). The T666M substitution alters one of the conserved residues in the P-segment. It is conceivable that an alteration of a P-segment affects the ion-selectivity or toxin binding of a channel gene.
The remaining two missense mutations identified in FHM families alter the S6 segment of the second and the fourth repeat. A valine to alanine substitution in FHM family UK-B is found in domain IIS6 at codon 714 (V714A). Domain IVS6 is mutated in two unrelated FHM families (NL-A and USA-C), predicting a isoleucine to leucine substitution at codon 1811 (I1811L). The V714A and I1811L missense mutations do not really change the neutral-polar nature of the amino acid residues. However, both S6 mutations are located nearly at the same residue at the intracellular site of the segment and are conserved in all calcium channel al subunit genes. In addition, the A-to-C transversion leading the I1811L substitution occurred in two unrelated FHM families on different haplotypes indicating recurrent mutations rather than a founder effect. Although the exact function of the S6 domains are not known, these data strongly suggest that mutations in IIS6 and IVS6 result in FHM.
The I1811L mutation is present in two FHM families of which one (NL-A) also displays a cerebellar atrophy in (some) affected family members. The presence of cerebellar atrophy in FHM families has been reported in about 40% of chromosome 19-linked FHM families, whereas none of the unlinked families was found to have cerebellar atrophy (Terwindt et al., 1996).
The I1811L mutation excludes the possibility of allelic mutations in FHM and FHM with cerebellar atrophy. However, it is likely that FHM or FHM with cerebellar atrophy are the result of pleiotropic expression of a single defective gene.
No mutation was found in a small Italian FHM family (Italy-I). Apart from the possibilities discussed for EA-2, it should be noted that linkage to 19p13 was only suggested but never proved with significant lod scores (M. Ferrari, personal knowledge).
The four missense mutations identified indicate a mechanism for FHM in which both alleles of the xcex11 subunit are expressed, one harbouring an amino acid substitution which affects the function of this calcium channel xcex11 subunit by reducing or enhancing the electrical excitability. The relationship of FHM and other types of migraine makes it highly rewarding to investigate the involvement of the only missense variant observed (A454T) (Table 2), and to continue the search for other variants of the exemplified invented gene specific for common types of migraine.
The mutations in EA-2 and FHM demonstrate among others that the brain specific calcium channel gene CACNL1A4 is responsible for both EA-2 and FHM, and is also involved in the primary pathogenesis of the more common forms of migraine. We conducted the common migraine study in an independent sample of 36 extended Dutch families, with migraine with aura and migraine without aura. We found significant increased sharing of the marker alleles in sibs with migraine with aura (MLS=1.29 corresponding with p≈0.013). Although no such increased sharing was found for migraine without aura, a combined analysis for both migraine types resulted in an even more significant increased sharing (MLS=1.69 corresponding with p≈0.005). These results clearly indicate the involvement of the calcium cSIA-subunit gene region on 19p13 in both migraine with and without aura; the contribution to migraine with aura, however, seems strongest.
The positive findings in our study clearly demonstrate an involvement of the FHM locus region in non-hemiplegic familial migraine, notably in migraine with aura. The P/Q-type calcium channel xcex11A-subunit gene on chromosome 19p13 may be an xe2x80x9caura-genexe2x80x9d and is involved in both FHM and migraine with aura, but not in migraine without aura. This however, seems unlikely since an increased sharing of marker alleles was also found when we combined the results for migraine with and without aura. Furthermore, the increase in sharing was stronger than expected to be only due to the contribution of migraine with aura. An alternative explanation is that the gene is involved in both types of migraine, but in migraine without aura there is an additional strong effect of other, possibly environmental factors, thereby reducing the penetrance.
The latter view is also supported by the results obtained from calculating the relative risk ratios (xcexR) for sibs from affected individuals to also have migraine. The relative risk ratio for a sib to suffer from migraine with aura was xcexR=2.4. When combining migraine with and without aura, xcexR was 1.25. In a population-based study the relative risk for first degree relatives of probands with migraine with aura to also have migraine with aura was xcexR=3.8. Because of the female preponderance among migraine patients, X-linked dominant or mitochondrial inheritance has been suggested to be involved in familial migraine. Although a predominant maternal inheritance pattern was noted in our families, X-linked dominant or mitochondrial inheritance were found to be highly unlikely because affected fathers transmit migraine to their sons. Furthermore, the predominant maternal inheritance can be explained by the female preponderance among the migraine patients.
We conclude that the well-established genetic contribution to the etiology of migraine is partly, but not entirely, due to genetic factors located in the chromosomal region of the P/Q-type calcium channel xcex11A-subunit gene. Further analysis of the cerebral distribution and function of this calcium channel, as well as of the xe2x80x9cmutated channelsxe2x80x9d, will help to unravel the pathogenetic pathway of migraine. It may also contribute to a better understanding of the mechanisms involved in related disorders such as episodic ataxia type-2, autosomal dominant cerebellar ataxia (SCA6), cerebral atrophy, and epilepsy, which all have been found to be associated with mutations in this gene. Study of FHM, EA-2 mutants and variants such as the A454T variant expressed in vitro or in mouse or other experimental animal models will ultimately lead to better understanding of the diseases, their cellular mechanisms, and the clinical relationship between FHM, EA-2, migraine, and other episodic neurological disorders such as epilepsy, and will provide rationales for the development of prophylactic therapy.
Localization and identification of the mouse gene related to the neurological mouse mutations tottering, leaning and rolling.
The tottering (tg) mutation arose spontaneously in the DBA inbred strain, and has been back-crossed into a C57BL/6J (B6) inbred strain for at least 30 generations. The genome of the tg mouse therefore is of B6 origin except for a small region around the tg gene on chromosome 8. Interestingly, the chromosome 8 region in mouse has synteny with the human chromosome 19p13.1, in which the human calcium channel alphal subunit has been identified. We therefore consider the tg locus as a possible site of the mouse homologue of the human calcium channel gene.
To determine the exact localization of the mouse homologue, PCR was carried out with primers based on human cDNA sequence selected from FIG. 1 and mouse genomic DNA aE template. In human, primers were known to be located in different flanking exons. POR amplification on human DNA yielded a 1.5kb fragment.
Forward primer (SEQ ID NO: 45)5xe2x80x2-caa cat cat gct ttc ctg cc-3xe2x80x2
Reversed primer (SEQ ID NO: 46)5xe2x80x2-atg atg acg gcg aca aag ag-3xe2x80x2
Amplification on mouse DNA yielded a 750-bp fragment. The fragment mainly consists of intronic sequences. SSCP analysis revealed several polymorphisms in the different inbred strains (each strain a specific pattern). Analysis of amplified product of the tg/tg (homozygote) and tg/+(heterozygote) mice demonstrated a DBA specific signal in the tg/tg mouse, and a heterozygous pattern of DBA and B6 inbred strains in the heterozygous tg/+mouse. These results show that the mouse homologue of the human calcium channel alphal subunit is located within the mouse tottering interval on chromosome 8.
In conclusion: the phenotypic characteristics of the tg mouse (tg/tg and tg/+) suggest involvement of ion-channels in the tg-etiology. The localization of the mouse homologue of the human calcium gene within the tottering interval show that a tottering phenotype in mouse is caused by a mutation in the mouse homologue of the CACNL1A4 gene. With various variants of the tottering mouse (the Jackson Laboratory, Bar Habor, Me., USA), such as the leaner and rolling varieties, such mutations in the mouse homologue of the CACNL1A4 gene can be found, clearly demonstrating that the gene is related to a variety of episodic neurologic disorders and using this genetic information one can engage in a variety of pathofysiological studies, as for example indicated below.
The tg mutation arose spontaneously in the DBA/2 inbred strain. tg/tg homozygotes are characterized by a wobbly gait affecting the hindquarters in particular, which begins at about 3 to 4 weeks of age, and by intermittent spontaneous seizures which resemble human epileptic absence seizures. The central nervous system of the mice appears normal by light microscopy. There is no discernible cerebellar hypoplasia. In fluorescent histochemistry studies tg/tg mice show a marked increase in number of noradrenergic fibers in the terminal fields innervated by locus ceruleus axons, the hippocampus, cerebellum, and dorsal lateral geniculate. Treatment of neonatal tg/tg mice with 6-hydroxydopamine, which selectively causes degeneration of distal noradrenergic axons from the locus ceruleus, almost completely abolishes the ataxic and seizure symptoms.
The leaner mutation of the tottering mouse arose spontaneously in the AKR/J strain. Homozygotes are recognized at 8 to 10 days of age by ataxia, stiffness, and retarded motor activity. Adults are characterized by instability of the trunk, and hypertonia of trunk and limb muscles. The cerebellum is reduced in size, particularly in the anterior region, in tg less than la greater than /tg less than la greater than mice, as is the case with a certain number of FHM patients. There is loss of granule cells beginning at 10 days of age and loss of Purkinje and Golgi cells beginning after 1 month. Cell loss later slows but continues throughout life. Granule and Purkinje cells are more severely affected than Golgi cells and the anterior folia more severely affected than other parts of the cerebellum. The cerebellum of tg less than la greater than /tg mice shows shrinkage and degenerative changes of the Purkinje cells. The loss in cerebellar volume in tg less than la greater than /tg and in tg/tg mice is specific to the molecular layer, with no change in volume of the granule cell layer or the white matter layer. Allelism of aleaner with tottering was shown in complementation and linkage tests.
A third variety of the tottering mouse is (tg less than rol greater than ) called the rolling Nagoya. Found among descendants of a cross between the SIII and C57BL/6 strains, the tg less than rol greater than mutation apparently occurred in the SIII strain. Homozygotes show poor motor coordination of hindlimbs that may lead to falling and rolling, and sometimes show stiffness of the hindlimbs and tail. No seizures have been observed. Symptoms are recognizable at 10 to 14 days old. They appear a little earlier than those of tg/tg mice and are somewhat more severe. The cerebellum is grossly normal until 10 days of age, but after that grows more slowly than normal. The size of the anterior part of the central lobe of the cerebellum is reduced with reduction in the numbers of granule, basket, and stellate cells but normal numbers of Purkinje cells. There is a reduced concentration of glutamate and an increased concentration of glycine and taurine in the cerebellum and decreased activity of tyrosine hydroxylase in the cerebellum and other areas.